Research Organizations

Research Summary

My training, research, and policy interests focus on the interface of recovery in psychiatric and substance use disorders with membership in society. I have investigated processes of recovery in psychosis, using peer support and other social engagement strategies in engaging people with co-occurring disorders and/or who are homeless into care, the development of qualitative and participatory research methods, the development and evaluation of innovative, community-based psychosocial interventions, and the promotion of collaborative relationships between people with behavioral health disorders and their healthcare providers. Much of this work has been oriented toward articulating a disability and civil rights perspective on psychiatric disorders, attempting to create an array of pathways into community life for people with psychiatric disabilities. Throughout this work, my colleagues and I also have attempted to identify and redress social, political, and economic disparities as they relate to healthcare, opportunities for recovery, and the participation of persons with disabilities in the activities, and communities, of their choice.

Extensive Research Description

There have been three major foci to my developing program of research: understanding processes of recovery in psychosis; developing and evaluating community-based and psychosocial interventions to promote recovery, and; designing and analyzing policies to foster community integration among people with psychosis. First, in collaboration with John Strauss I was able to articulate, develop, and apply empirical-qualitative methods to the study of psychosis and processes of recovery. Initially through a series of longitudinal interviews with people living with, and at times recovering from, psychosis I identified a number of common elements in the processes involved in improvement. These findings led to a series of papers beginning in 1992 in which my colleagues and I described the various roles the person with the disorder can play in his or her own recovery as well as in the recovery of his or her peers. Primary among the elements involved in these processes were (re-) establishing a sense of efficacy as a social agent and a sense of belonging among one's non-disabled peers.

These appeared to provide cornerstones of recovery, especially for a population that had developed a secondary disability due to prolonged symptoms, impairment, demoralization, and social isolation. Beginning in 1995, we then began to apply these insights, through a participatory research approach, in the development and evaluation of psychosocial interventions designed collaboratively with people with prolonged psychosis. Through studies of individual and groups forms of peer support, we identified a number of potential avenues of access for people with disabilities to exit the psychiatric ghettos of community-based systems of care and return to the broader community. This research initially was taken up by the Mental Health Consumer Movement both in the U.S. and elsewhere, and then began to impact clinical psychiatry when we were able to demonstrate the effectiveness of this approach in enhancing participants' social functioning and decreasing their use of intensive and costly services. These studies also have since served as the impetus for large-scale, controlled studies funded by the National Institutes of Health and Substance Abuse and Mental Health Services Administration assessing the effectiveness of peer-based and culturally-responsive interventions in increasing access to care and improving functional outcomes among people with psychosis.

On somewhat of a parallel track, my work in public policy has been devoted to developing systems of care that promote the recovery and community integration of people with psychiatric disabilities. These efforts at the local, state, and federal level have involved introducing evidence-based, recovery-oriented, and culturally responsive services and structures across systems of care, and evaluating their effectiveness in improving patient and service system outcomes. Examples of our contributions include peer engagement as an alternative to mandated outpatient treatment and the use of psychiatric advance directives to extend a person's capacity to make his or her own healthcare-related decisions during times of distress or disorganization.

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